Dr. Annie Answers: Breastfeeding 101

Happy World Breastfeeding Week! Given the celebration of lactation we are in, I wanted to get out a quick and dirty, insider basics style guide to breastfeeding for mamas to be or current lactaters. It’s not comprehensive – for more details, please check out La Leche League, Kelly Mom and/or get a lactation consultation or talk with your own provider! These are just some hard-won tips of the trade.

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On demand means on freaking demand

Breastfeeding is not easy, people. I have lots of family doctor and OBGYN mommy friends who have ALL said at one point or another, “this was so much harder than I though it would be!” … and of all people we should know what to expect! Some people certainly have an easier go of things than others – a challenge rather than the literal blood, sweat and (so many) tears battle other mamas fight through. But if it’s possible to get your baby that “liquid gold”, the health benefits are innumerable for you and babe alike. Also… No shaming here for the mamas who truly can’t make it work! Breast is best, but fed is a damn close second.

1) Initiation

Starting breastfeeding off right begins at birth. This is a super important part of breastfeeding going well with less difficulty. Many hospitals around the country have signed on to the “Baby-Friendly Hospital” guidelines to help mom and baby get an optimal start to breastfeeding and bonding, which is FANTASTIC! This includes (see Baby Friendly USA for more info) 10 items the hospital must comply with to show they are on board with supporting breastfeeding.

Probably the most important of all is recommendation #4: “Help mothers initiate breastfeeding within 1 hour of birth”.

This goes along with another important recommendation that isn’t always included in hospital protocols: The Magical or Golden Hour. Babies should be delivered and immediately placed naked, skin-to-skin with mom and kept that way for at LEAST 1 hour after birth. That means no bath first (there is actually very good evidence your baby should NOT be bathed in the hospital at all to keep their healthy skin flora), no shots, no eye ointment, and assessments done ON MOM unless there is an urgent medical concern that requires otherwise for the first hour of life.

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Sweet Mimi in her Golden Hour

This is not the favorite policy of many Labor and Delivery floors because it delays some of the tasks needed to wrap up post-delivery care. As much as I love and hugely appreciate my L&D RN friends, this efficiency concern gets a big ol

The Magical Hour is profoundly helpful in establishing proper physiology, bonding and strong initiation of latch and breastfeeding and should be protected. It is truly magical. Most babies will, completely independently, literally crawl up mom to the breast and latch themselves properly with practically no intervention. Check out the YouTube video and hundreds of others if you don’t believe me.

There are, unfortunately, sometimes medical emergencies that make this not possible. That’s ok too! Do as close to this as you can. Mom can’t do skin-to-skin? Dad/partner/birth partner can do it. Baby needs to be monitored more closely? Get mom or dad touching them as soon as it’s medically safe. Once you can, do skin-to-skin for as many hours of the day as you can to catch up. Some wonderful providers have even started doing skin-to-skin in the OR for their cesarean birth patients when it is safe. Do your best!

2) After The First Latch, Lube it Up

After you get that initial magical latch in, the real fun starts. Bring in and use nipple oil (I prefer coconut oil, some use lanolin or compounded ones with both) after EVERY feed. Warm it gently between your fingers and slather it on there. Wipe off any excess gently with your breast pad before the next feed – but no need to wash off.

Whichever your choose (if you can, buy a small one of each and figure out which you like best), try to pick an organic one – we’re talking about some of the very first things to go into your baby’s mouth and gut. Spring for the best.

3) Ask for Help

If you don’t have a doula to personally help you, ask for help from the birth center. Most hospitals now have staff lactation specialists who can come help you. DON’T pass this up!!! Unless you’re an ultra experienced mom of multiple babes or lactation nurse yourself, have them check you out. Get comfortable with what to look for in a good latch and have them demonstrate with you and your actual baby several different positions.

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upside down side lying position to sooth baby for photo shoot… not super highly recommended

 

If you don’t have access to one right away, there is guaranteed to be an experienced nurse on the floor who can help and then schedule your lactation consult for after discharge. La Leche League website is a great place to find local support and resources for follow up.

4) Fuel Up

You’ll need to eat and drink a LOT for your body to make enough good milk. You should aim for 3-4 liters of water or other hydration daily. Keep a LARGE water receptacle by you at all times. Make sure your support person knows to refill when low. If you’re thirsty, you’re already over a quart of water low.

Breastfeeding burns up to 800 calories a day in the early days. As you’re starting out, you’ll want to eat like a teenage boy doing two-a-day practices in the middle of a growth spurt. All of a sudden, the crazy guy who speed-eats 100 hot dogs will seem somewhat reasonable. Go for it. If you want to be “healthier”, focus on getting in LOTS of fat and protein and limiting stuff with chemical additives or added sugar. Yes fat. You’ll burn it off later – don’t worry. No dieting of any kind until after 6 weeks when your milk is established. period.

5) Forget All Else

This is the last of the basics I’m gonna throw at you. For the first month (or two) of your baby’s life, breastfeeding should be your only task. If people want to come over? Great! they have to be people who 1) you’re ok with seeing your boob flopping around and 2) be willing to do chores with 3) no actual promise of holding or even touching the baby. Let everything else go – you eat, sleep and breastfeed.

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or not sleep…

Breastfeeding on demand (which will feel like the full 24 hours of the day) is the best way to make sure your milk comes in and your baby has enough. Almost no one truly does not make enough milk if they initiate feeding on demand without formula (or nosy know-it-all in-law) interference. Let your baby’s health care provider guide you on whether there’s enough milk getting in. Your job isn’t to guesstimate volume of milk, it’s to put a boob in the baby’s mouth every time they seem hungry. TheMilkMeg sums it up:

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Happy Feeding Mamas!

Dr. Annie is a family doctor and mom of 2 with 1 on the way with 25 months personal breastfeeding experience and lots more hours helping others. Please add your questions and personal tips to comments below! Let’s help each other this week and all weeks!

Dr. Annie Answers: Kid Vitamin Basics

Mother’s Day is this weekend which has me thinking about all the things moms have to worry about… one of the most common being the nutrition and health of our precious little ones. Almost every day at my clinic, I get some sort of question about vitamins – What’s safe? What’s necessary? Where do I get good ones? The answer, of course, varies by your particular health needs and should be discussed with your own medical provider. A few things are pretty generalizable though and I’ll delve into them here by age. This post is about kiddos – coming up next will be an adult version, so make sure you FOLLOW US to get that update!

Breastfed Babies, Birth through 12 months: 400 units Vitamin DScreen Shot 2018-03-09 at 2.08.17 PM

Vitamin D is needed for all babies who are breastfed half or more of their milk intake. I nearly always recommend Baby Ddrops for those who can afford the $10/month averaged cost. These are concentrated drops so, instead of getting your tiny baby to choke down a whole milliliter of vitamin D like the generic ones at the pharmacy, you only have to put 1 drop on your clean finger and put on baby’s tongue before a feeding. If your baby is formula fed, no vitamins needed, they’re already in there – see below for details.

Breastfed Babies, 4 months through 12 months: Add 6-11mg Iron

Iron is recommended for breast-fed babies after the first 3 months of life. Mom’s iron from the womb keeps them going up until that 4 month mark.

Sidenote…. One of the potential benefits of delayed cord clamping at birth is increasing baby’s iron stores for that first 3-4 month period (great review on this by Dr. Raju et al here.) . This is, of course, an important thing to discuss with your own pregnancy care provider, but worth considering for this and other benefits if there is no reason not to do it.

From ~4 months through the rest of the first year, baby will start eating more and more ‘real’ foods which can supply some iron, but usually not enough. The recommended amount by the American Academy of Pediatrics for babies 7-12 months is 11mg per day. For reference, you’d have to get your baby to eat 2 cups of cooked spinach to get that much – not gonna happen.

Option 1: at this age, stop Vitamin D supplement and change to multivitamin. Poly-vi-sol with iron is the go-to recommendation for most health care providers. However, my daughters both projectile vomited it, so we had to use alternatives. Other options are Zarbees Baby Multivitamin with Iron  and Honest Company makes an easy-to-give vitamin powder: Link herepexels-photo-533360.jpeg

Option 2: continue with Ddrops and give iron-only supplement like this one or give a serving of iron-enriched cereal daily. I personally, along with a growing number of pediatric care providers, recommend the former along with introducing iron-rich foods such as pureed meats, dark leafy vegetables, beets and beans before cereals as part of a healthier early diet. Baby cereals don’t otherwise have much in the way of nutrition or “taste education” for that little one. (References here in AAP News and here from NIH)

Formula-fed Babies up to 1 year

Breast-milk is best for moms and babies that can do it in all aspects except these 2 vitamins. Formula comes conveniently stocked with both Vitamin D and Iron so you don’t have to worry about the supplements. Certainly not a reason to choose it over breastmilk, but a nice side-benefit if it ends up being the right option for you. I usually recommend Baby’s Only Organic Formula or Plum Organics Grow Well Formula. Screen Shot 2018-05-07 at 5.58.09 PMThey are well tolerated (review here), have the right amount of all important nutrients and both come out to roughly $1/ounce (compare to Similac Advance Non-GMO at $1.25/ounce). They are also organic and free of corn syrup solids and chemical additives – which, when you’re talking about the ENTIRE nutrition of your tiny rapidly growing baby is important. AND!! You can get them both on auto-ship from Amazon so no leaving the house – bonus!

After 1 year: Vitamin D 400-1000 Units Daily +/- others…pexels-photo-61129.jpeg

This now depends on how picky of an eater your kid has become. If you have that amazing, adventurous eater who loves a variety of meats, fruits, and vegetables and drinks 2+ cups of milk per day, multivitamins are unnecessary. If your child doesn’t get 400-1000 units Vitamin D from fortified milk and other foods, they will need a vitamin D supplement again. Why? What about kids before the advent of vitamins?? Well, kids were outside ALL DAY without sunscreen back then. We now know better and protect their skin – the downside of which is low vitamin D.

If you do have a picky eater  – even if you’re not sure how picky is picky – a multivitamin can fill in the gaps. Again, the above mentioned Zarbee’s and Honest options are great as is Renzo’s Picky Eater Multi. If they’re getting extra of some of those vitamins, they will pee them out.

Hang on…. I hear a question coming out of the Ether….

“Dr. Annie, are the examples you listed above the only good options?? What about Flintstone’s vitamins or Olli Chewables?” Of course those aren’t the only vitamin brand options. If you want to check out others, just read the fine print on the label on the back and make sure they have the right amounts of the recommended vitamins.

Wait…. another one coming in…. “What about probiotics??” I’m so glad you asked! YES probiotics are so important from infancy through the rest of life – so important I’m going to write a separate post all about it ;^)

94 Dr. Annie is a family physician, wife and mom of 2 picky eaters In the Sacramento Area.

Friday Faves: Margo’s Go-To For Working/Busy Moms

Hi friends!

I want to throw some things out there (like my besties did) that I have found to be stellar items as a working/busy/tired mom.  (Brad Pitt dancing has nothing to do with this but I liked the gif, so there you go.  Happy Friday!)

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1. Pumping on the go Accessories.  Before I even start with this, please know that FED is best.  So, while I personally loved breastfeeding, I have no judgements about how you feed your kids.  If you are a breastfeeding mama, I have a suggestion that changed. my. life.  One of the hardest things for me was finding time to pump.  Enter: hands-free pumping in the car (while I was driving, YES!). Working mamas who have jobs that require you to be out and about meeting with people and SAH mamas who spend their day driving kids around, running errands, and being a superwoman alike can benefit.

I put my Medela Pump on the passenger seat, zipped on my hands free pumping bra, plug in, put my cover on (to avoid peering eyes) and voila!  I was driving and making/storing milk.  HOWEVER, I noticed that I was going through a TON of batteries, and sometimes the pump batteries would poop out on me at the worst moments.  No bueno.

So, my husband set me up with a plug in the car.  Game changer!  Never again was I mid-pumping and realized I had no more power in the pump and ended up engorged.

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(Note: Do not do ANYTHING dangerous while driving.  I always set up the pump before I left my parking spot. Also note:  One time I got pulled over while pumping, but that’s a funny story for another time.  The only thing you need to know is that the police officer was super nice to me and I didn’t get a ticket for speeding!)

2.  Cooler cooler: Once you are done pumping?  Get that liquid gold on ice!  I used a small YETI Hopper cooler because it kept my milk SUPER cold, even in the summer, and for me was worth the investment.  I even did this all on a plane once (Southwest Airlines rocks!) and a male passenger chatted me up about how awesome it was to use a YETI to store breastmilk.  Now that I am done breastfeeding, my husband uses it for beer – Win, win for everyone.  Easy peasy, tata squeezy.  What did we do without/before technology?

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3. Kid Tracker.  You may think I am crazy for this one, but what the heck!  Judgement free zone, right?  I got this GPS tracker and watch for my each of my two kids.  I. Love. Them. I can see where they are at all times.  I can set up a perimeter and it will notify me if they leave that area (like my yard).  There is also an alarm if they try to take it off (or if someone tries to take it off of them).  It has two-way communication, and it has an emergency number they can dial.  It will also listen in on conversations (creepy I know) but if you are worried about an adult trying to approach them inappropriately in a public place like a large playground, this helps.  I have a big yard, you guys.  I want to be able to sit in the sun and let my kids run around.

Screen Shot 2018-04-26 at 6.09.29 PMOne day, before I had this, my son decided to visit a neighbor’s grandma who he loves (inside their house) without asking for permission.  One minute he was riding his bike in the driveway and the next minute he was gone, and the bike was laying at the end of my driveway.  Scariest five minutes of my life when I couldn’t find him.  I was running down the street screaming his name.  I had the police on the phone.  I legit thought someone had stolen him.  Not interested in that experience ever again!

4. Help with cooking.  Have I mentioned I am not very good in the kitchen?  Understatement of the century.  I have a dear friend (Hi Jennie!), though, who helps me out with this by getting me access to super awesome and necessary tools, like the Ceramic Egg Cooker.

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My Ceramic Egg Cooker makes me feel like SuperWoman in so many ways. I can enjoy a hot wrap with a perfectly Scrambled Egg (Who knew I was capable of that?), or make each kid a personalized order of Gluten Free Oatmeal (I didn’t even know what this was before Jennie)…  

This product is so multi-functional, and at only $15.50 it definitely gets it’s money’s worth!  Jennie made a page for our readership here: Pampered Chef Fundraiser.  Since May is Whip Cancer Month, a portion of anything you buy gets donated to American Cancer Society!  Getting this stuff has made it SO much easier for this tired, time-crunched and not-so-talented-chef mama when it comes to feeding my family.

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HAPPY SHOPPING!!!!!!